Provider Demographics
NPI:1871716506
Name:FAMILY PHYSICAL THERAPY OF SOUTH MS
Entity type:Organization
Organization Name:FAMILY PHYSICAL THERAPY OF SOUTH MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:228-863-4080
Mailing Address - Street 1:19020 PINEVILLE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4564
Mailing Address - Country:US
Mailing Address - Phone:228-863-4080
Mailing Address - Fax:228-863-4014
Practice Address - Street 1:19020 PINEVILLE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4564
Practice Address - Country:US
Practice Address - Phone:228-863-4080
Practice Address - Fax:228-863-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3128261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00356883Medicaid
MS00356883Medicaid
MSQ24754Medicare ID - Type UnspecifiedINDIVIDUAL UPIN #
MS451781Medicare ID - Type UnspecifiedGROUP UPIN #
MSC03455Medicare ID - Type UnspecifiedGROUP PROVIDER #
MS=========OtherTAX ID #